Division of Cardiology, Rosalind Franklin University of Medicine and Sciences, Chicago, IL, USA.
Catheter Cardiovasc Interv. 2011 Feb 1;77(2):163-70. doi: 10.1002/ccd.22647.
Current guidelines recommend against the revascularization of noninfarct related artery (complete revascularization [CR]) in patients with ST elevation myocardial infarction (STEMI) and no hemodynamic compromise, though level of evidence is C.
Our aim was to examine the available evidence to determine any advantage of CR over culprit only revascularization (COR).
We systematically searched medline using key words-"culprit coronary revascularization," "complete revascularization myocardial infarction," and "multivessel STEMI" for studies reporting outcomes after COR versus CR during primary procedure or index hospitalization published in English language and indexed before February 2010. A random effect or fixed effect meta-analysis, as applicable, was performed using RevMan 5 (Cochrane Center, Denmark).
Nine eligible nonrandomized studies amounting to 4,530 patients in CR and 27,323 patients in COR group were included. In addition, two small randomized trials were reviewed and included in secondary analysis. Majority of patients were hemodynamically stable. Major adverse cardiovascular events (Odds ratio [OR] = 0.95, 95% CI 0.47-1.90) and long term mortality (OR = 1.10, 95% CI 0.76-1.59) were similar. The marginal increased odds of in-hospital mortality was derived from a single study with no difference found after sensitivity and cumulative analysis (OR = 1.21 95% CI 0.85-1.73).
Current analysis of heterogeneous studies did not reveal any benefit of CR over COR in patients with STEMI. However, also provide no conclusive evidence of increased in hospital mortality after CR. A randomized trial is needed to confirm these findings and recognize any subgroup which might benefit from CR.
目前的指南建议在 ST 段抬高型心肌梗死（STEMI）且无血流动力学障碍的患者中不进行非梗死相关动脉血运重建（完全血运重建[CR]），尽管证据水平为 C 级。
我们旨在研究现有证据，以确定 CR 相对于罪犯血管血运重建（COR）的优势。
我们使用关键术语系统地检索了 Medline-“罪犯冠状动脉血运重建”、“完全血运重建心肌梗死”和“多支 STEMI”，以查找在主要治疗过程或索引住院期间报告 COR 与 CR 后结果的研究，这些研究以英文发表并在 2010 年 2 月前进行了索引。适用时，使用 RevMan 5（丹麦 Cochrane 中心）进行随机效应或固定效应荟萃分析。
纳入了 9 项符合条件的非随机研究，共计 4530 例 CR 患者和 27323 例 COR 患者。此外，还回顾了两项小型随机试验并将其纳入次要分析。大多数患者血流动力学稳定。主要不良心血管事件（比值比[OR] = 0.95，95%可信区间 0.47-1.90）和长期死亡率（OR = 1.10，95%可信区间 0.76-1.59）相似。住院死亡率的边际增加几率来自一项单一研究，但在敏感性和累积分析后没有差异（OR = 1.21，95%可信区间 0.85-1.73）。
对异质性研究的当前分析并未显示 CR 相对于 COR 在 STEMI 患者中有任何优势。然而，也没有提供 CR 后住院死亡率增加的明确证据。需要进行随机试验来证实这些发现，并确定可能从 CR 中受益的任何亚组。
